DR ELLIE CANNON: Is this pain in my gut down to IBS… or my recent back injury?

I have suffered from irritable bowel syndrome (IBS) for a long time, but I was able to control the pain fairly well. However, earlier this year I injured my back while bending. Now I have an almost constant pain deep in the intestines. I can’t figure out if this is gut or back related. Could a scan detect the source of my pain?

Because IBS is a chronic condition, it can be difficult to determine whether this is the cause of new pain. The pain associated with IBS is very specific in nature and recognizable to patients.

It usually causes a cramp-like pain that worsens after eating and is influenced – for better or worse – by the opening of the intestines. This cramp-like pain is the tightening of the muscles in the intestines, which often come and go in waves.

Of course, people with IBS suffer from different types of pain, but persistent pain in the intestines is not typical.

It would not be unusual to have abdominal pain caused by a back injury. The entire abdominal wall is held firm by muscles, and a back injury will put pressure on the muscles in the front. This can lead to abdominal sprains.

Another cause of pain in this area can be a hernia – a weakness in a muscle wall that allows the internal contents behind it to penetrate. They are common in the abdomen and cause anything from a dull ache to persistent pain.

To assess where the pain comes from, a GP examination is best. The abdomen and back should be viewed and tested for movements or positions that are causing the pain.

Before each appointment, it is useful to keep a pain diary. This involves documenting when and how the pain arises and what happened that day. This can be an invaluable tool in identifying when the pain symptoms occur, often aiding doctors in their diagnosis.

I have noticed that my right ankle has started to tilt, as if it needs to be supported when I walk. I am in my fifties, I walk a lot and am otherwise fit and not overweight. I usually wear shoes with support, but I want to prevent it from getting worse. What do you recommend?

When an ankle feels unreliable, or as if it is giving way, it is often a condition called ankle instability. Patients notice that they feel unsteady on that foot, especially if the floor is uneven or during exercise. Some patients will notice swelling and occasionally feel pain.

An ankle often becomes unstable after a sprain – an excessive pulling or tearing of the ligaments, the tissues that support the bones. In the ankle, the ligaments hold everything in place, keeping the ankle firm but mobile during all movements.

Instability is more likely in people who have repeated sprains in the same foot. A sprained ankle ligament is one of the most common sports injuries.

The diagnosis is usually made by a general practitioner or physiotherapist. An MRI may also be needed to assess the damage.

Physical therapy is the first form of treatment for ankle instability, in an attempt to strengthen the muscles and ligaments. Improving your balance and supportive shoes and orthotics in shoes can be vital. An ankle brace may also be recommended; this holds the ankle in place and prevents further damage.

If it doesn’t go away, surgery is an option, but most patients won’t need it.

For the past two years I have had an extremely itchy back. I went to my local surgery and they had no answer – my skin is very clear with no obvious signs of irritation. Coincidentally, this has happened since Covid vaccinations started, and I wondered if there might be a connection. Have you heard of anyone else suffering the same thing or, better yet, that there are solutions? I am 80 years old.

Itching is very annoying and becomes even worse if no cause is found.

Skin infections, such as scabies, and dermatitis, such as eczema, are obvious culprits, as are allergies and irritations caused by detergents used on bedding and pajamas, for example.

Medications can cause itching without a visible rash and can continue to do so even if you stop taking them. Some sources include: blood pressure tablets, such as amlodipine or irbesartan; diabetes drugs metformin and gliclazide; gout drug allopurinol; and painkillers, including codeine. The GP can decide whether these should be stopped or exchanged.

Even if no cause is found, it is still important to undergo treatment to limit the disturbing side effects. This may include the use of antihistamines or creams. Loose cotton clothing also limits skin irritation, as does staying cool.

Although itching is a common side effect of medications, it should certainly become less common in the long run. As Covid vaccinations are still relatively new, it would be worth reporting this to the adverse event monitoring body via the MHRA’s yellow card system. A pharmacist or GP can help you with this, but it can also be done online.

Combat gambling addiction – by tackling the stigma

Reports suggest that six in 10 adults in Britain who have experienced problems with gambling have never spoken to anyone about it. I find this incredibly worrying.

Gambling addiction is a serious health problem that affects almost 300,000 people in Britain, while a further 3.5 million people are negatively affected by someone else’s gambling problem.

People who have had a gambling addiction are twice as likely to develop depression and anxiety than those who have not. One in five problem gamblers admit to having had suicidal thoughts in the past year.

And yet gambling is often a hidden addiction, much easier to hide than alcohol or drug abuse. This makes it all the more dangerous.

The problem can affect anyone, and from my work I know that all kinds of people – men, women and all age groups – can fall victim to gambling.

We need to create a society where people feel comfortable admitting they have a problem. Only then can we ensure that everyone who needs treatment can receive it.

I would encourage anyone who is struggling to speak to their GP or look at the Gambleaware website (begambleaware.org).

Don’t miss your vital swab test

I was shocked to learn that a third of women invited for cervical cancer screening did not take up the offer.

The screening is designed to detect signs of the human papillomavirus (HPV) in the cervix, which is responsible for 99 percent of cancer cases. If HPV is spotted, further tests will be done to see if there are any changes in the cells of the cervix, which could be early signs of cancer.

The NHS invites all women aged 25 to 64 for the smear test every three to five years. The program saves thousands of lives every year by detecting the disease early enough to cure it. But it appears that the number of women showing up for their screening has slowly declined in recent years.

Make no mistake: Missing this test could be the difference between life and death. If you are invited for a cervical examination, I recommend that you go.